University of Lethbridge, 4401 University Drive, Lethbridge, Alberta, T1K 3M4, Canada
Rural Remote Health. 2021 Feb;21(1):6231. doi: 10.22605/RRH6231. Epub 2021 Feb 10.
In rural settings, many healthcare professionals experience intersections of professional and personal relationships, often known as dual roles. Dual roles are traditionally studied in terms of their potential for ethical conflicts or negative effects on care. In the existing scholarship, there is little discussion of dual roles in long-term care (LTC) settings, which present distinct conditions for care. Unlike other forms of health care, LTC work is provided daily, over longer periods, in care recipients' home environments. This article outlines results from a case study of LTC in rural Alberta, Canada and provides evidence of some of the challenges and, more notably, the considerable benefits of dual roles in these settings.
The qualitative data discussed in this article come from a multi-site comparative case study of rural LTC that, among other questions, asked, 'How do personal and professional lives intersect in rural LTC settings across the province?' These data were collected through the use of rapid ethnographies at three rural LTC homes across the province of Alberta. The research team conducted semi-structured, in-depth interviews (n=90) and field observations (~200 hours). Participants were asked about care team dynamics, the organization of care work, the role of the LTC home in the community, and the intersections of public and private lives. The results were coded and critically analyzed using thematic analysis.
Dual roles were primarily described as beneficial for care provision. In many cases, dual roles provided participants with opportunities for reciprocity, enhanced person-centered care, and increased perceptions of trust and community accountability. Similar to what has been documented in the extant literature, dual roles also presented some challenges regarding personal and professional boundaries for those in leadership. However, the negative examples were outweighed by positive accounts of how dual roles can serve as a potential asset of rural LTC.
There is a need for more nuanced conversations around the implications of dual roles. Policies and care approaches need to emphasize and support the use of good judgment and the responsible navigation of dual roles, rather than taking either a permissive or prohibitive approach. Leaders in rural LTC can promote conversations among care providers, with an emphasis on the cultural context of care provision and how dual roles play out in their specific professional practice. Blanket policies or educational approaches that frame dual roles as necessarily problematic are not only insensitive to the unique nature of rural LTC, but prohibitive of relational elements that these results suggest are highly supportive of person-centered care.
在农村地区，许多医疗保健专业人员都经历着职业和个人关系的交集，通常被称为双重角色。传统上，双重角色是根据其潜在的伦理冲突或对护理的负面影响来研究的。在现有的学术研究中，很少有关于长期护理（LTC）环境中双重角色的讨论，而这些环境为护理提供了独特的条件。与其他形式的医疗保健不同，LTC 工作是在护理接受者的家庭环境中每天提供的，时间更长。本文概述了加拿大艾伯塔省农村 LTC 案例研究的结果，并提供了一些证据，证明了在这些环境中双重角色存在一些挑战，更值得注意的是，它们具有相当大的益处。
本文讨论的定性数据来自艾伯塔省农村 LTC 的多地点比较案例研究，除其他问题外，该研究还询问了“在全省农村 LTC 环境中，个人和职业生活如何交叉？”这些数据是通过在该省三个农村 LTC 家庭进行快速民族志研究收集的。研究小组进行了半结构化的深入访谈（n=90）和现场观察（~200 小时）。参与者被问及护理团队动态、护理工作组织、LTC 家庭在社区中的作用以及公共和私人生活的交集。结果使用主题分析进行编码和批判性分析。
双重角色主要被描述为提供护理的有益方式。在许多情况下，双重角色为参与者提供了互惠的机会，增强了以患者为中心的护理，并提高了对信任和社区问责制的认知。与现有文献中记录的情况类似，双重角色对于处于领导地位的人来说，在个人和职业界限方面也带来了一些挑战。然而，积极的例子超过了对双重角色如何成为农村 LTC 的潜在资产的负面描述。
需要更细致地讨论双重角色的影响。政策和护理方法需要强调并支持良好判断力的使用，以及对双重角色的负责任管理，而不是采取放任或禁止的方法。农村 LTC 的领导者可以促进护理提供者之间的对话，重点关注护理提供的文化背景以及双重角色在其特定专业实践中的表现。框架为双重角色必然存在问题的一般性政策或教育方法不仅对农村 LTC 的独特性质不敏感，而且禁止了这些结果表明非常支持以患者为中心的护理的关系元素。
